What is Carpal Tunnel Syndrome?

The carpal tunnel is a narrow canal at the base of the wrist through which pass several tendons and the median nerve, the nerve responsible for motion and sensation in parts of the hand. Carpel tunnel syndrome (CTS) occurs when the median nerve is damaged by being compressed or entrapped in the very restrictive confines of the carpal tunnel. The syndrome manifests itself primarily as numbness, weakness or pain in the thumb, index, middle and ring fingers, although similar symptoms may extend to the forearm and shoulder.

Causes of Carpal Tunnel Syndrome

Strictly speaking, CTS is an idiopathic condition despite its popular association with typing and other repetitive tasks. The condition is linked, however, to a variety of both intrinsic and extrinsic factors that tend to increase pressure on the median nerve, including obesity, inflammatory diseases like rheumatoid arthritis and tumors that impinge upon the carpal tunnel, and the incidence of the condition is undeniably highest in people performing repetitive manual tasks.

While establishing formal causation remains elusive, there is a very strong association with the workplace, as the condition is most prevalent in the working population, and with certain repeated manual tasks and specific wrist positions. A 2006 review of the existing literature by the National Institute for Occupational Safety and Health accepted this strong correlation but stopped short of acknowledging any particular causation.

What are the Symptoms of Carpal Tunnel?

The classic symptoms of the syndrome are tingling or numbness in the fingers or palm. These symptoms can be accompanied by weakness in the hand, difficulty gripping objects, and pain in the elbow, shoulder and other parts of the arm. Left untreated, the characteristic numbness may become increasingly painful, the hand may become swollen, especially at night, and the muscles in the palm at the base of the thumb may weaken and atrophy.

Carpal Tunnel Syndrome Treatment Options

Non-Surgical Treatment

The most popular non-surgical treatment is the use of a brace or splint on the affected wrist, accompanied by treatment with non-steroidal anti-inflammatory drugs. Braces may be rigid or flexible and should be worn through the night for best results. For more advanced cases, a corticosteroid injection can provide temporary symptomatic relief, but long-term improvement generally requires behavioral change, whether a change in activity, postural improvement or the use of new equipment that minimizes stress on the wrist.

Surgical Treatment

Surgery is the best option for people who have not responded to non-surgical intervention and who experience muscle weakness, atrophy or constant numbness. The surgical procedure is known as carpal tunnel release and can be performed as either an open procedure or an endoscopic procedure.

In the open procedure, an incision up to two inches in length is made in the palm and wrist, exposing the ligament that covers the carpal tunnel. That ligament is cut along its length to relieve any pressure on the median nerve.

In the endoscopic procedure, the ligament receives identical treatment, but the carpal tunnel is accessed through a tiny incision and an endoscope is used to view the internal structure.

Both procedures have high rates of success. The open procedure tends to have a longer recovery time and more tenderness at the site of the incision. The endoscopic procedure entails a shorter recovery time, but this may be offset by a slightly higher rate of complications.

SECTR

OPEN PROCEDURE

Stitchless

5-10 sutures

1/4 inch scar

3 inch scar

Little to no scar sensitivity

Tender scar for months, possible permanent

Small dressing

Splint for 3 weeks

May get dressing wet

Must keep dry for 3 weeks

Usually no therapy

4-8 weeks of therapy

Light activities Immediately

Light activities at 3 weeks

Return to strenous work at 1 month

Return to strenous work at 3 months

Recovery Time

Recovery time for carpal tunnel release surgery varies according to the severity of the condition and how long it had lasted prior to surgery. In general, patients can expect a recovery period of two weeks to several months, but it may take up to a year to reach peak improvement. Returning to work prematurely may cause symptoms to recur.

Carpal Tunnel Syndrome Synopsis

If you are suffering from hand numbness, tingling or piercing pain that shoots through your wrist and all the way up your arm, it’s time to see a Carpal Tunnel Specialist in Orange County. It’s possible that your ailment could be Carpal Tunnel Syndrome. With Carpal Tunnel Syndrome you may feel some kind of itching sensation in the palm of your hand especially near the index, middle finger and the thumb. Carpal Tunnel issues have increased over the past five years due to the extensive computer use of people in work force. It’s becoming more and more important to work in an ergonomically friendly position.

The symptoms usually worsen during the night when you are sleeping and it will slowly progress into something more serious. A person experiencing Carpal Tunnel Syndrome may have difficulty flexing your fingers, grasping small objects and so on. Two types of Carpal Tunnel release surgery are normally standard: Open Procedure surgery and Endoscopic Carpal Tunnel Release (ECTR). The former is the oldest and most traditional way of treating Carpal Tunnel.

Open Procedure starts with an incision in your wrist to cut the carpal ligament and enlarge the carpal tunnel. Since it’s a minor surgery, it is usually done in the outpatient area and under local anesthesia. However, the scarring can be a bit unseemly (see pics above) and the recovery period is much slower than Endoscopic Carpal Tunnel Release (ECTR).

There are advantages of Endoscopic Carpal Tunnel Release (ECTR) in that there is usually little post-operative discomfort. The Carpal Tunnel surgeon makes an incision in the wrist, inserts a camera to observe the tissue in the location and cuts the carpal ligament. ECTR is also performed using local anesthetic. There are two-portal and one-portal endoscopic surgery. Recovery from Endoscopic Carpal Tunnel Release (ECTR) will start the moment the surgery is finished and takes two weeks to several months, but it can take up to 1 year for peak improvement.

Dr. John Knight is one of the top Carpal Tunnel Surgeons in Southern California and he has performed hundreds of Open Procedure and Endoscopic Carpal Tunnel Release (ECTR) operations. Dr. Knight is a board certified, Fellowship-trained orthopedic surgeon. With more than 20 years of experience in the field, he will employ the most minimally invasive techniques treats his patients with care and attention.